Evolución de los parámetros hematológicos y óbito en internados con COVID-19 en un hospital de Paraguay, 2021

Introducción: Los parámetros hematológicos proporcionan al equipo médico marcadores pronósticos útiles en la evolución clínica de la enfermedad de COVID-19. El objetivo fue analizar la relación entre la evolución desfavorable de los valores hematológicos y el óbito de los pacientes internados con COVID-19. Metodologia: El estudio es observacional, correlacional y longitudinal. Se realizó la revisión de fichas clínicas de los pacientes mayores a 18 años internados entre enero y marzo del 2021. Se registró en una planilla Excel el resultado de los parámetros hematológicos al ingreso, a las 48 horas, a los 8 días y al egreso. Los datos fueron analizados con Epi Info 7.1 (CDC, Atlanta) según estadística descriptiva. Resultados: De 144 pacientes, se observaron 68 (47,2%) muertes, con predominio del sexo masculino (63,2%) y, mayores a 60 años (47,1%). Los factores asociados a mortalidad fueron la hipertensión (52,9% vs 31,6%; p=0,009), la diabetes (50% vs 26,3%; p=0,003) y, la obesidad (41,2% vs 25%; p=0,039). Los parámetros hematológicos desfavorables asociados a la mortalidad se presentaron a partir de los 8 días de internación con leucocitosis (64,1% vs 33,3%; p=0,003), linfopenia (96,8% vs 79%; p=0,008), neutrofilia (98,5% vs 87,7%; p=0,029) y, un elevado índice neutrófilo/linfocito (INL) (96,9% vs 75,4%; p=0,001). Discusión: Los parámetros hematológicos que se asociaron con la mortalidad fueron leucocitosis con neutrofilia, linfopenia e INL elevado. Estos parámetros podrían tener valor pronóstico en el seguimiento para contribuir en el manejo de estos pacientes.

Introduction: Hematological parameters provide the medical team with useful prognostic markers in the clinical evolution of COVID-19 disease. The objective was to analyze the relationship between the unfavorable evolution of hematological values and the death of patients hospitalized with COVID-19. Methodology: The study is observational, correlational, and longitudinal. A review of the clinical records of patients over 18 years of age hospitalized between January and March 2021 was carried out. The results of the hematological parameters at admission, at 48 hours, at 8 days and at discharge were recorded in an Excel spreadsheet. The data were analyzed with Epi Info 7.1 (CDC, Atlanta) according to descriptive statistics. Results: Of 144 patients, 68 (47.2%) deaths were observed, with a predominance of males (63.2%) and those over 60 years of age (47.1%). The factors associated with mortality were hypertension (52.9% vs 31.6%; p=0.009), diabetes (50% vs 26.3%; p=0.003) and obesity (41.2% vs 25 %; p=0.039). The unfavorable hematological parameters associated with mortality occurred after 8 days of hospitalization with leukocytosis (64.1% vs 33.3%; p=0.003), lymphopenia (96.8% vs 79%; p=0.008), neutrophilia (98.5% vs 87.7%; p=0.029) and a high neutrophil/lymphocyte ratio (NLR) (96.9% vs 75.4%; p=0.001). Discussion: The hematological parameters that were associated with mortality were leukocytosis with neutrophilia, lymphopenia, and elevated NLR. These parameters could have prognostic value in follow-up to contribute to the management of these patients.

Comparison of platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in women with preterm premature rupture of membranes and women with preterm delivery

Background: Considering the adverse effect of PROM on birth outcomes and the condition of mother and fetus, early identification of risk factors of PROM and their control can reduce the occurrence of adverse outcomes for mother and fetus and improve their health. This study was conducted with the aim of comparing PLR and NLR in women with PROM and women with preterm delivery. Methods: This case-control study was conducted on 155 women with PPROM as case group and 155 women with preterm delivery as control group. Age, gestational age, type of delivery, baby's birth weight, gravida, parity, APGAR score, rate of hospitalization in Neonatal Intensive Care Unit (NICU), occurrence of neonatal sepsis and development of respiratory distress syndrome (RDS) were recorded from women's medical records. Also, the results of blood tests and PLR and NLR values were calculated for each pregnant woman. Collected data were analyzed by statistical methods in SPSS version 24. Results: The average gestational age and weight of babies at birth time in the case group were significantly lower than those with preterm delivery. The mean of NLR in case group with 4.8±2.5 was significantly higher than control group with 4.2±2.2. The mean of PLR in case group with 111.5±47.6 was significantly higher than control group with 100.98±43.4. Conclusions: The high values of PLR and NLR in the women with PROM compared to women with preterm delivery can be a marker to identify the risk of PPROM in pregnant women.

Prediction of Prognostic Features Based on Neutrophil-Related Genes for Lung Squamous Cell Carcinoma Reveals Immune Landscape and Drug Candidates

ABSTRACT Background: Since to the prognosis of lung squamous cell carcinoma is generally poor, there is an urgent need to innovate new prognostic biomarkers and therapeutic targets to improve patient outcomes. Objectives: Our goal was to develop a novel multi-gene prognostic model linked to neutrophils for predicting lung squamous cell carcinoma prognosis. Methods: We utilized messenger RNA expression profiles and relevant clinical data of lung squamous cell carcinoma patients from the Cancer Genome Atlas database. Through K-means clustering, least absolute shrinkage and selection operator regression, and univariate/multivariate Cox regression analyses, we identified 12 neutrophil-related genes strongly related to patient survival and constructed a prognostic model. We verified the stability of the model in the Cancer Genome Atlas database and gene expression omnibus validation set, demonstrating the robust predictive performance of the model. Results: Immunoinfiltration analysis revealed remarkably elevated levels of infiltration for natural killer cells resting and monocytes in the high-risk group compared to the low-risk group, while macrophages had considerably lower infiltration in the high risk group. Most immune checkpoint genes, including programmed cell death protein 1 and cytotoxic T-lymphocyte-associated antigen 4, exhibited high expression levels in the high risk group. Tumor immune dysfunction and exclusion scores and immunophenoscore results suggested a potential inclination toward immunotherapy in the "RIC" version V2 revised high risk group. Moreover, prediction results from the CellMiner database revealed great correlations between drug sensitivity (e.g., Vinorelbine and PKI-587) and prognostic genes. Conclusion: Overall, our study established a reliable prognostic risk model that possessed significant value in predicting the overall survival of lung squamous cell carcinoma patients and may guide personalized treatment strategies. (Rev Invest Clin. 2024;76(2):116-31)

Neutrophil lymphocyte ratio and platelet lymphocyte ratio as a marker for disease severity in children with COVID-19

Background: It had been observed that there is relationship of neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) with disease severity in children with COVID-19 and post-COVID, multisystem inflammatory disease in children (MIS-C). Study conducted to determine NLR and PLR correlation with this disease severity.Methods: Prospective descriptive analytical study conducted at the children抯 hospital and university of child health sciences, Lahore. Consecutive confirmed cases of COVID-19 infection and post-COVID, MIS-C diagnosed on the basis of RT-PCR from nasopharyngeal swab and antibody test admitted from March 2020 to October 2021 were included through consecutive sampling. Complete blood (CBC) was done and NLR and PLR was determinedResults: Majority 198 (74.2%) of the 267 patients had a diagnosis of COVID-19 and 69 (25.8%) were post-COVID MIS-C. There was a male preponderance 177 (66.3%) and the mean age was 6.1�7 years (95% CI: 5.62-6.74). Majority children had mild disease 80 (30%), 34 (12.7%) were critical and there were 37 (13.8%) deaths. Underlying comorbidity was present in 55 (20.6%). As the severity of symptoms changed from asymptomatic to severe disease, there was a significant rise of mean NLR from 1.88�40 to 5.47�77 respectively (p<0.001). PLR however, failed to show any kind of association with severity of the symptoms (p=0.922).Conclusions: NLR served as a marker of disease severity among pediatric patients suffering from COVID-19 and MIS-C. However, PLR failed to show any relation with disease severity.

Clinical characteristics and laboratory profile of symptomatic COVID-19 patients from a tertiary Bangalore rural hospital: the lessons learnt

Background: Aim of study was to analyse clinical and laboratory features and outcome of COVID-19 patients admitted in second wave of pandemic (April1 to May 31, 2021) (SW) and compare with covid 19 patients in third wave (TW). Methods: COVID-19 positivity were confirmed in both SW and TW. Demographic features, symptoms and duration were recorded. X ray chest was done at the time of admission and for monitoring. Complete blood count, C reactive protein, renal function tests, liver function tests, LDH and D dimer levels were done. The positive patients were categorized as mild, moderate and severe based on the clinical, imaging and laboratory features. Results: Among 297 patients screened, 171 patients were diagnosed as positive (57.5%). 107 patients were admitted (62.5%). (M:F ratio - 1.74:1). The most common symptoms for hospitalization were fever, cough and shortness of breath. Though 38 patients had neutrophilia, only 16 of them presented with high NLR ratio. Consolidation on chest X-ray was present in all patients but the degree varied. 38 patients required ICU admission and oxygen support. 18 patients succumbed to disease. Among 140 patients (TW) (December 1 to January 31 2022, 69 (43.1%) were positive. Only 12 patients required hospitalisation. The only symptom was high fever. The NLR ratio ranged from 1-6 and never went beyond 6. All patients were discharged after 2-3 days. Conclusions: The demographic features, co morbidities, presenting symptom of fever and X ray findings were similar in both waves. But the NLR ratio was never beyond 6 in TW. This was probably due to early reporting and vaccination status of the population and less virulent strain of the virus in TW. The present study confirmed that raised NLR and low levels of oxygen saturation at the time of admission are important predictors of disease severity.

Efficacy analysis of blood inflammation and liver function indexes in ICP diagnosis and delivery mode prediction / 重庆医学

Objective To observe the changes of laboratory blood indexes in patients with intrahepatic cholestasis of pregnancy(ICP),and analyze the value of blood inflammation indexes and liver function indexes in the diagnosis of ICP and the prediction of delivery mode.Methods A total of 251 patients diagnosed with ICP in this hospital from January 2021 to December 2022 were selected as the ICP group,and another 200 healthy pregnant women were selected as the control group.The patients with ICP were further divided into the severe ICP group(n=47)and the mild ICP group(n=204),the vaginal delivery group(n=113)and the cesarean section group(n=138)according to the severity of ICP and delivery mode.Mann-Whitney U test was used for comparison of parameters between groups,and Spearman method was used for correlation analy-sis.Receiver operating characteristic(ROC)curves were used to evaluate the efficacy of laboratory indicators in diagnosing ICP and predicting delivery mode.Results Neutrophil/lymphocyte ratio(NLR)[6.01(4.45,8.37)vs.3.36(4.12,3.51)]and aspartate transaminase(AST)level[20.00(16.00,33.00)U/L vs.15.00(13.00,18.00)U/L]in the ICP group were significantly higher than those in the control group(P＜0.05),and NLR in the severe ICP group was significantly higher than that in the mild ICP group[4.93(3.87,7.35)vs.4.14(3.12,5.17),P＜0.05].Correlation analysis showed that NLR was positively correlated with AST level(r=0.279,P＜0.001)and ICP severity(r=0.139,P=0.028)in patients with ICP.The area under ROC curve(AUC)of NLR combined with AST for ICP diagnosis was 0.882(95％CI:0.851-0.913).In ad-dition,cholinesterase(CHE)[6 020.00(5 499.50,6 703.50)U/L vs.5 341.50(4 651.75,6 259.25)U/L]and prealbumin(PA)[199.00(177.71,225.20)mg/Lvs.169.17(139.18,204.40)mg/L]levels in the va-ginal delivery group were significantly higher than those in the cesarean section group(P＜0.05),and the AUC of CHE combined with PA for predicting vaginal delivery in ICP patients was 0.727(95％CI:0.664-0.789).Conclusion NLR and AST have potential value in the diagnosis of ICP,and CHE and PA have poten-tial value in predicting delivery mode of ICP patients.

Peripheral blood eosinophil/neutrophil as an independent risk factor for recurrence after treatment in children with bronchial asthma / 国际检验医学杂志

Objective To investigate the effect of eosinophil(EOS)/neutrophil(NER)in peripheral blood on asthma recurrence in children with bronchial asthma(BA)after treatment.Methods A prospective cohort study was conducted in the study.BA children admitted to the hospital from February 2020 to February 2022 were selected as the research objects.All children were treated regularly and their condition was under con-trol.After a follow-up of 6 months,the recurrence of the children was recorded.EOS/NER,interleukin(IL)-4 and IL-5 of children with and without relapse before treatment and at 1 week of treatment were compared.Lo-gistic regression analysis model was established to test the effect of EOS/NER on the recurrence of asthma in children with BA after treatment.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of EOS/NER,IL-4 and IL-5 before treatment for the recurrence risk of BA children after treatment.Results A total of 128 children with BA were included.25 cases recurred after 6 months of follow-up,with a recurrence rate of 19.53%.EOS/NER,IL-4 and IL-5 of BA children after 1 week of treatment were lower than those before treatment(P<0.05).EOS/NER,IL-4 and IL-5 of recurrent children before treat-ment and 1 week after treatment were higher than those of non-recurrent children(P<0.05).There were no statistically significant differences in EOS/NER,IL-4,IL-5 levels between children of different genders,age groups,and treatment regimens before and after 1 week of treatment(P>0.05).Increased EOS/NER,in-creased level of IL-4 and increased level of IL-5 had effect on the recurrence of BA children after treatment and may be risk factors for recurrence(OR>1,P<0.05).The ROC curve showed that area under the curve of EOS/NER before treatment for predicting the recurrence was 0.810(95%CI:0.724-0.896,P<0.001)in BA patients after 6 months of treatment,with moderate predictive value.Conclusion EOS/NER before treat-ment in BA children may be an independent risk factor for recurrence after treatment,and has moderate pre-dictive value for recurrence risk.

Changes of serum CXCL16 and ANCA levels in allergic rhinitis and their clinical significance / 国际检验医学杂志

Objective To investigate the levels of serum CXC-chemokine ligand 16(CXCL16)and anti-neu-trophil cytoplasmic antibody(ANCA)in patients with allergic rhinitis and their clinical diagnostic value.Meth-ods A total of 84 patients with allergic rhinitis(allergic rhinitis group)treated in the hospital from January to December 2022 were selected as the study objects,and were divided into mild group(44 cases)and moderate and severe group(40 cases)according to the severity of their disease.Another 80 healthy subjects who had physical examination in the same period were selected as the control group.The levels of CXCL16 and ANCA in serum were determined by enzyme-linked immunosorbent assay.The correlation between serum CXCL16 and ANCA levels and inflammatory factors[interleukin(IL)-4,IL-9,IL-13]and immunoglobulin E(IgE)was analyzed by Pearson.The value of serum CXCL16 and ANCA levels in the diagnosis of moderate and severe allergic rhinitis was evaluated by receiver operating characteristic(ROC)curve.Results Compared with con-trol group,the levels of IL-4,IL-9,IL-13 and IgE in allergic rhinitis group were significantly increased,and the difference was statistically significant(P＜0.05).Compared with control group,serum CXCL16 and ANCA levels in allergic rhinitis group were significantly increased,and the differences were statistically significant(P＜0.05).The area under the curve(AUC)of serum CXCL16 and ANCA in patients with allergic rhinitis was 0.897 and 0.844,respectively.The AUC of combined diagnosis was 0.959,both of which were better than that of individual diagnosis(Z=2.164,3.474,P＜0.05),and the specificity was 93.75％.The sensitivity was 89.29％.The levels of serum CXCL16 and ANCA in patients with allergic rhinitis increased with the se-verity of the disease(P＜0.05).Pearson correlation analysis showed that serum CXCL16 and ANCA levels were positively correlated with IL-4,IL-9,IL-13 and IgE in patients with allergic rhinitis(P＜0.05).ROC curve analysis results showed that the AUC of the patients diagnosed with moderate and severe allergic rhini-tis by serum CXCL16 and ANCA was 0.862 and 0.832,respectively,and the AUC of the combined diagnosis of CXCL16 and ANCA was 0.949,both of which were better than those diagnosed separately(Z=1.981,2.378,P＜0.05),and the specificity was 90.91％.The sensitivity was 90.00％.Conclusion The levels of se-rum CXCL16 and ANCA in patients with allergic rhinitis increased significantly,and increased with the severi-ty of the patients'disease,both of which have certain value in the clinical diagnosis of allergic rhinitis.

Prediction of efficacy of early-stage tumor markers combined with NLR and PLR for immunotherapy in gastric cancer / 国际肿瘤学杂志

Objective:To explore the predictive value of early serum tumor markers (STM) , neutrophil to lymphocyte ratio (NLR) , platelet to lymphocyte ratio (PLR) combination score on the efficacy of gastric cancer immunotherapy.Methods:A total of 76 patients with gastric cancer who received immunotherapy at Second Affiliated Hospital of Shandong First Medical University from January 1, 2020 to June 30, 2022 were selected. Patients' leading STM, NLR, PLR were collected. Optimal cut-off value of NLR and PLR were determined by the receiver operating characteristic (ROC) curve. The clinical efficacy and prognosis of different leading STM, NLR, PLR and combined scores in gastric cancer patients received immunotherapy were analyzed. ROC curve was used to evaluate the predictive efficiency of each index and the combined score. Cox regression model was used to analyze the factors affecting patients' survival.Results:The best truncation value for NLR was 2.75, and the best truncation value for PLR was 175.9. All patients completed at least 2 cycles of immunotherapy, the objective response rate (ORR) was 23.7% (18/76) , and the disease control rate (DCR) was 88.2% (67/76) . There were no significant differences in ORR [ (20.9% (9/43) vs. 27.3% (9/33) ], DCR [83.7% (36/43) vs. 93.9% (31/33) ] between the high NLR group ( n=43) and low NLR group ( n=33) ( χ2=0.42, P=0.519; χ2=1.02, P=0.313) . There were no significant differences in ORR [27.3% (12/44) vs. 18.8% (6/32) ], DCR [81.8% (36/44) vs. 96.9% (31/32) ] between the high PLR group ( n=44) and low PLR group ( n=32) ( χ2=0.75, P=0.388; χ2=2.71, P=0.555) . The ORR for the high combined score group ( n=39) and low combined score group ( n=37) was 17.9% (7/39) and 29.7% (11/37) , respectively, with no statistically significant difference ( χ2=1.46, P=0.230) ; the DCR was 79.5% (31/39) and 97.3% (36/37) , respectively, with a statistically significant difference ( χ2=4.19, P=0.041) . The median progression free survival (PFS) and overall survival (OS) of 76 patients were 8.0 and 12.0 months. The median PFS in the high NLR group and low NLR group was 7.0 and 10.0 months, respectively, with a statistically significant difference ( χ2=7.95, P=0.005) ; the median OS was 12.0 and 14.0 months, respectively, with no statistically significant difference ( χ2=1.04, P=0.307) . The median PFS in the high PLR group and low PLR group was 8.0 and 10.0 months, respectively, with a statistically significant difference ( χ2=3.90, P=0.048) ; the median OS was 13.0 and 13.0 months, respectively, with no significant difference ( χ2=0.02, P=0.896) . The median PFS in the high combined score group and low combined score group was 7.0 and 10.0 months, respectively, with a statistically significant difference ( χ2=13.52, P<0.001) ; the median OS was 12.0 and 14.0 months, respectively, with a statistically significant difference ( χ2=5.02, P=0.025) . ROC curve analysis showed that the area under curve (AUC) of leading STM, NLR, PLR and combined score to predict the efficacy of gastric cancer immunotherapy was 0.662, 0.697, 0.601 and 0.773. Univariate analysis showed that, surgery ( HR=0.59, 95% CI: 0.36-0.95, P=0.031) , leading STM ( HR=0.57, 95% CI: 0.34-0.93, P=0.026) , NLR ( HR=0.54, 95% CI: 0.34-0.87, P=0.011) , combined score ( HR=0.42, 95% CI: 0.26-0.68, P<0.001) were all influencing factors for PFS in gastric cancer patients received immunotherapy; tumor stage ( HR=0.30, 95% CI: 0.12-0.75, P=0.011) , leading STM ( HR=0.28, 95% CI: 0.15-0.50, P<0.001) , combined score ( HR=0.55, 95% CI: 0.31-0.96, P=0.036) were all influencing factors for OS in gastric cancer patients received immunotherapy. Multivariate analysis showed that, leading STM ( HR=0.56, 95% CI: 0.33-0.98, P=0.041) was an independent influencing factor for PFS in gastric cancer patients received immunotherapy; tumor stage ( HR=0.29, 95% CI: 0.11-0.76, P=0.012) , leading STM ( HR=0.32, 95% CI: 0.17-0.58, P<0.001) , combined score ( HR=0.46, 95% CI: 0.25-0.82, P=0.009) were all independent influencing factors for OS in gastric cancer patients received immunotherapy. Conclusion:The combined score of leading STM, NLR and PLR is an independent factor influencing OS in patients receiving immunotherapy for gastric cancer, and can predict the efficacy of immunotherapy for gastric cancer.

Glabridine regulates NETs to inhibit pyrodeath and alleviate lung injury in sepsis / 中华急诊医学杂志

Objective:To investigate the effect of glabridin on neutrophil extracellular traps (NETs) formation and pyroptosis in rats with sepsis-induced lung injury.Methods:Twenty-four male Wistar rats were divided into three groups according to the random number table method. The sepsis group was established by cecal ligation and puncture (CLP). The Glabridin group underwent CLP and glabridin gavage (30 mg/kg)(CLP+GLA). The sham operation group underwent cecal exploration, and only the abdomen was closed after cecal turning(Sham). After 12 hours, plasma、alveolar lavage fluid and lung tissue samples were taken for detection . Then, protein content of the alveolar lavage fluid was determined; The wet/dry weight(W/D) ratio of the lung tissue was determined; The pathological changes in lung tissue were observed after hematoxylin-eosin (HE) staining. The levels of NETs marker MPO-DNA complex and related inflammatory factors IL-18 and IL-1β in plasma were detected by enzyme-linked immunosorbent assay. The changes of Caspase-1and Cleaved-caspase-1 protein in lung tissue were detected by Western blot.Results:The total protein concentration of alveolar lavage fluid was significantly higher in the sepsis group compared with the Sham group ( P<0.01), and it decreased in the glabridin group compared with the sepsis group ( P<0. 05). Significant aggravation of pulmonary edema in the sepsis group, and the glabridin group reduced pulmonary edema compared with the sepsis group.The pathological results of lung tissue under the light microscope showed: The structure of lung tissue in the Sham group was normal, and the alveoli were clear; In the sepsis group, the alveolar wall was thickened widely and inflammatory cells infiltrated obviously; Compared with the sepsis group, the lung tissue injury was significantly reduced in the light licorice group. The enzyme-linked immunosorbent assay results showed that the levels of NETs marker MPO-DNA complex and inflammatory factors IL-18 and IL-1β in the plasma of the sepsis group were significantly higher than those in the Sham group ( P<0.001). The levels of NETs marker MPO-DNA complex and inflammatory factors IL-18 and IL-1β in the glabridin group were significantly lower than those in the sepsis group (MPO-DNA: P<0. 01; IL-18、IL-1β: P<0.05) . Western blot Technical results showed that the expression of Caspase-1 and Cleaved-caspase-1 protein positive signal was significantly enhanced in the lung tissue of the rats in the sepsis group compared with the Sham group; the distribution of Caspase-1 positive cells in the lung tissue of the sepsis + glabridin group was similar to that of the Sham group, and the expression of Cleaved-caspase-1 positive signal was higher than that of the Sham group. Conclusions:Glabridin can effectively reduce lung inflammation and play a protective role in lung injury in septic rats by inhibiting NETs production and pyroptosis.

Predictive value of inflammatory markers on the risk of stroke-associated pneumonia in acute ischemic stroke patients / 临床神经病学杂志

Objective To explore the predictive value of inflammatory markers for stroke-associated pneumonia(SAP)in patients with acute ischemic stroke(AIS)based on the nomogram model.Methods According to whether pneumonia occurred,259 AIS patients were divided into SAP group(81 cases)and non-SAP group(178 cases).The clinical data of the two groups were compared.The systemic inflammatory response index(SIRI),systemic immunoinflammatory index(SII)and neutrophil to lymphocyte ratio(NLR)were calculated according to the formula.The variables with statistically significant differences were included in the multivariate binary Logistic regression model to screen out the independent risk factors for SAP in AIS patients.The independent risk factors were used to construct a predictive model,and the predictive ability of the two models,which only included traditional factors and included inflammatory indicators at the same time,was further compared from the aspects of discrimination,calibration,clinical practicability and so on.Reclassification analysis was used to evaluate the extent to which the nomogram model improved the predictive value of SAP risk in AIS patients.Results Compared with those in the non-SAP group,the rates of smoking,diabetes,dysphagia,leukocytes,neutrophils,lymphocytes,triglyceride level,NIHSS score on admission,SIRI,SII and NLR were significantly increased in the SAP group,and the rate of hypertension was decreased(all P＜0.05).Diabetes mellitus(OR =2.505,95%CI:1.070-5.850,P =0.034),dysphagia(OR =3.492,95%CI:1.501-8.119,P =0.004),NIHSS score on admission(OR = 1.310,95%CI:1.188-1.446,P＜0.001),SIRI(OR =2.417,95%CI:1.327-4.401,P =0.008),NLR(OR =1.434,95%CI:1.101-1.860,P =0.007)were independent risk factors for SAP in AIS patients.The area under the curve was 0.788(95%CI:0.725-0.852,P＜0.001)for the prediction model without inflammatory factors and 0.884(95%CI:0.838-0.930,P＜0.001)for the prediction model with independent risk factors.The calibration curve showed a good consistency between the predicted risk and the observed results.The decision curve showed that the model had a significant net benefit for predicting SAP.In addition,by calculating the net reclassification index(NRI)and the comprehensive discriminant improvement index(IDI),it was found that the nomogram model had a significant improvement in predicting the risk of SAP in AIS patients.Internal verification also proves the reliability of the nomogram model.Conclusions SIRI and NLR are independent predictors of SAP in AIS patients on admission.Adding SIRI and NLR to the traditional model can significantly improve the ability to identify the risk of SAP occurrence in AIS patients.

Study on a clinical model of predicting severe asthma centered on peripheral blood neutrophils and oxidative stress molecules / 复旦学报（医学版）

Objective To compare the clinical characteristics,peripheral blood inflammatory cells and levels of oxidative stress indicators between severe asthma and non-severe asthma patients,analyze the effects of neutrophils and oxidative stress molecules on the severity of asthma,and build a biological model for early prediction of severe asthma.Methods From Aug 2018 to Jul 2019,67 adult patients with stable asthma in our hospital were enrolled in this study.The clinical characteristics,peripheral blood inflammatory cells and levels of oxidative stress indicators of severe asthma group and non-severe asthma group were compared.Single factor Logistic regression analysis was conducted on severe asthma to screen out the most important five variables.Multifactor Logistic regression analysis was further conducted to establish a prediction model for severe asthma.Results There were 25 severe asthma patients in this cohort,who had a longer course of disease,more frequent acute attacks,poorer asthma control,higher peripheral neutrophils,more severe obstructive ventilation dysfunction,lower myeloperoxidase(MPO)level and higher superoxide dismutase(SOD)than non-severe asthma patients.The patients with higher peripheral blood neutrophil count or proportion were more likely to show severe asthma,more frequent acute attacks,and more obvious reduction of pulmonary ventilation function.A panel of biomarkers,centered on peripheral blood neutrophil count and oxidative stress indicators SOD,human 8-epi-prostaglandin F2α(8-iso-PGF2α),could build a model to predict severe asthma.Conclusion There are significant differences in clinical characteristics,peripheral blood inflammatory cells,and oxidative stress index levels between severe asthma patients and non-severe asthma patients.In stable asthma patients,levels of neutrophils and oxidative stress indicators such as SOD had an impact on the severity of asthma.The prediction model of severe asthma established on this basis provides a new idea for early recognition of severe asthma.

Serum Cytokines,PCT and NLR Expression Levels and Their Diagnostic Value in Patients with Sepsis / 现代检验医学杂志

Objective To explore the value of cytokines,procalcitonin(PCT)and neutrophil-lymphocyte ratio(NLR)in the early diagnosis and prognosis evaluation in the patients with sepsis.Methods 98 patients with sepsis admitted to the First Affiliated Hospital of Air Force Medical University from January 2020 to January 2023 were selected as research objects,including 82 patients in the sepsis non-shock group and 16 patients in the sepsis shock group.According to the death within 28 days,the patients was divided into survival group(n=82)and death group(n=16).Meantime,95 cases of non-septic infection group were included as control.The expression of interleukin(IL)-1β,IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12p70,IL-17,tumor necrosis factor(TNF)-α,interferon(IFN)-γ,IFN-α,PCT,and NLR were detected within 24h after admission,and their relationship with sepsis was analyzed by ROC curve.Results ①The IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12p70,IL-17,TNF-α,IFN-α,NLR and PCT in patients with sepsis were significantly higher than those in healthy subjects(Z=0.43～30.54,all P＜0.05)except IL-1β,IFN-γ.Further analysis of ROC showed that IL-8,NLR,PCT and IL-17 had strong predictive ability,with area under curve(AUC)of 0.78(95%CI:0.71～0.84),0.81(95%CI:0.75～0.87),0.83(95%CI:0.78～0.88),0.86(95%CI:0.81～0.92),respectively.Combined detection of the four indicators can effectively improve the diagnostic efficiency of sepsis,with the AUC of 0.90(95%CI:0.85～0.93).② There were no significant differences in cytokines,PCT and NLR concentration between positive and negative blood culture groups(P＞0.05),suggesting that these indexes were not affected by blood culture detection results.③Among the patients in the shock group,IL-6[122.10(10.77～10 000.00)ng/L]was significantly higher than that in non-shock group[25.56(1.02～9 096.74)ng/L],the difference was statistically significant(Z=74.55,P=0.01),with the AUC of 0.73(95%CI:0.59～0.87).The levels of IL-10[10.69(1.12～1 338.00)ng/L],IL-2[12.52(0.86～280.42)ng/L]and IL-5[9.55(0.93～259.57)ng/L]in sepsis death group were higher than those[2.55(0.34～695.13)ng/L,4.46(0.13～625.43)ng/L,2.75(0.01～117.88)ng/L]in survival group,the differences were statistically significant(Z=3.64,6.37,4.74,all P＜0.05),and the AUC were 0.69(95%CI:0.53～0.85),0.71(95%CI:0.56～0.85)and 0.72(95%CI:0.58～0.87),respectively.Conclusion The combined detection of IL-8,NLR,PCT and IL-17 is helpful for the early diagnosis of sepsis.The increase of IL-6 level can effectively predict the occurrence of septic shock,and the high expression of IL-10,IL-2 and IL-5 has a good predictive value for the death of sepsis patients.

Evaluation and analysis of short diameter of lymph nodes measured by enhanced CT combined with neutrophil to lymphocyte ratio in lymph node metastasis of cervical cancer / 实用放射学杂志

Objective To investigate the value of short diameter of lymph nodes combined with neutrophil to lymphocyte ratio(NLR)in evaluating lymph node metastasis of cervical cancer by enhanced CT.Methods A total of 82 patients with cervical cancer were selected and divided into metastatic group(n=13)and non-metastatic group(n=69)according to whether lymph node metas-tasis occurred.The clinicopathological features of the two groups were compared,and the relationship between NLR and clinicopath-ology was analyzed.Logistic regression was used to analyze the influencing factors of lymph node metastasis of cervical cancer.The short diameter of lymph nodes and serum NLR were compared between the two groups.Receiver operating characteristic(ROC)curve,DeLong test and compare the area under the curve(AUC)analysis was used to evaluate the value of lymph node metastasis in cervical cancer.The diagnostic efficacy of the above indexes were compared between the two groups.Results The short diameter of lymph nodes and NLR in the metastatic group were(0.686±0.120)cm and 2.23±0.41 respectively,while thosein the non-metastatic group were(0.602±0.106)cm and 1.76±0.30 respectively.The difference between the two groups was statistically signifi-cant(P＜0.05);There was no significant difference in age,growth pattern and vascular infiltration between the metastatic group and the non-metastatic group(P＞0.05).There were significant differences in clinical stage,maximum diameter of tumor,NLR and short diameter of enhanced CT lymph nodes(P＜0.05);The NLR was related to clinical stage,pelvic lymph node metastasis,and the short diameter of lymph nodes on enhanced CT scan(P＜0.05);Clinical stage Ⅲ,maximum diameter of tumor≥4 cm,NLR＞1.80 and short diameter of enhanced CT lymph nodes≥0.632 cm were independent risk factors for cervical cancer lymph node metastasis(P＜0.05);The ROC curve analysis showed that the AUC of the combined detection of cervical cancer was 0.871,higher than that of the enhanced CT lymph nodes short diameter and serum NLR(0.645,0.795),and its specificity was better than that of the independent detection.The best cutoff values of the enhanced CT lymph nodes short diameter and serum NLR were 0.630 cm and 1.91,respectively.Conclusion The short diameter of lymph nodes and the serum NLR can predict lymph node metastasis of cervical cancer,and the combined detection can improve the evaluation efficiency.

Prediction of isocitrate dehydrogenase status of glioma via diffusion tensor imaging parameters and clinical features / 实用放射学杂志

Objective To noninvasively predict isocitrate dehydrogenase(IDH)status of glioma via combining imaging and clini-cal features before surgery,so as to provide basis for individualized clinical treatment decision.Methods A total of 47 patients with glioma confirmed by pathological and molecular genetic tests were included,including 20 with IDH mutant type and 27 with IDH wild type.After diffusion tensor imaging(DTI)scanning,fractional anisotropy(FA)and mean diffusivity(MD)values of tumor paren-chyma were calculated.Combining DTI parameters with MRI morphological features of tumor,blood neutrophil/lymphocyte ratio(NLR)and patient's age,binary logistic regression model was established to effectively predict IDH status of glioma patients before surgery.Results There were significant differences in FAmean/FANAWM,MDmin,NLR,tumor location and age between IDH mutant type and IDH wild type groups(P<0.05).The binary logistic regression model concluding,FAmean/FANAWM,MDmin,cystic degeneration,NLR and age,predicted IDH status of glioma with area under the curve(AUC)of 0.961 and 95%confidence interval(CI)of 0.914-1.00.Conclusion The regression model established via combining DTI,MRI morphological features and blood NLR has great performance in classifying IDH status of glioma,and can help predict IDH status noninvasively before surgery,so as to assist clinical individualized treatment.

Association of anti-neutrophil cytoplasmic antibodies with the disease activity in patients with systemic lupus erythematosus / 实用医学杂志

Objective To investigate the clinical significance of ANCA in the disease activity of patients with SLE.Methods A total of 1 025 SLE patients were recruited and were divided into inactive and active groups according to SLEDAI score.Demographic characteristics,clinical symptoms,autoantibodies,routine laboratory tests and renal pathology were also recorded and compared between the two groups.Results All patients were divided into inactive group(n = 750)and active group(n = 250).The occurrence of renal,pulmonary,cutaneous,arthritis manifestations were significantly higher than those of the inactive group(all P<0.05).All patients were tested for ANCA,and the most common pattern being perinuclear or p-ANCA,the percentage of p-ANCA seroposi-tive increased greatly with the increased disease activity(P<0.05).The autoantibodies were further analyzed between the two groups,25 patients had reactivity to MPO,but no patient had reactivity to PR3.Also,there were significant differences in anti-dsDNA antibody,anti-nucleosome antibody between the two groups(P<0.05).In the active group,patients with p-ANCA seropositive exhibited higher serum beta-2-microglobulin(β2-MG),titers of anti-dsDNA antibody,SLEDAI scores,lower albumin,C3,and C4 levels(P<0.05).Meanwhile,p-ANCA was associated with IL-6,which increased significantly with the increase of SLEDAI score.In addition,patients with p-ANCA seropositive had more occurrence of lupus nephritis,but it had no association with the renal pathology.Conclusion The appearance of p-ANCA in SLE patients indicated more severe disease activity status.

Correlation Between Neutrophil/HDL-C Ratio and Severity of Coronary Artery Lesion in Young Adults with Acute Myocardial Infarction / 华中科技大学学报(医学版)

Objective To investigate the relationship between neutrophil/high-density lipoprotein cholesterol ratio(NHR)and the severity of coronary artery lesions in young adults with acute myocardial infarction.Methods A total of 109 young a-dults(aged 18～45 years)with acute myocardial infarction admitted to the First Affiliated Hospital of Anhui Medical University from June 2019 to June 2023 were selected and divided into Syntax low-risk group(n=85)and Syntax medium-high-risk group(n=24)according to Syntax score.Patients with negative coronary angiography during the same period were negative control group(n=52).General clinical data and related serum markers were collected,and NHR value was calculated.Pearson correla-tion analysis and logistics regression analysis were performed to examine the correlation between NHR and the severity of coro-nary artery lesions.Subgroup analysis and interaction testing were further conducted.The receiver operating curve(ROC)was performed to evaluate the value of NHR in predicting the severity of coronary artery lesions in young adults with acute myocar-dial infarction.Results Gender,smoking rate,alcohol consumption rate,diabetes history,absolute number of neutrophils,tri-glyceride,HDL-C,NHR,VLDL-C,apolipoprotein B(APOB),fasting blood glucose and glycosylated hemoglobin were signifi-cantly different among the three groups(P＜0.05).In pairwise comparison,the absolute number of neutrophil and NHR were significantly different among the three groups.BMI was significant different between non-CHD group and Syntax medium-high-risk group.HDL-C,fasting blood glucose and glycosylated hemoglobin were significant different between Syntax low-risk group and non-CHD group,as well as between Syntax medium-high-risk group and non-CHD group(P＜0.05).Creatinine and APOB were significant different between Syntax low-risk group and non-CHD group.Triglyceride,VLDL-C and LP(a)were significant different between Syntax low-risk group and Syntax medium-high-risk group(P＜0.05).Pearson correlation analysis showed a positively correlation between NHR and Syntax score(r=0.322,P＜0.01).Univariate and multivariate binary logistic regres-sion analysis showed that NHR(OR=1.265,95％CI1.097～1.458,P＜0.05)was an independent risk factor for the severity of coronary artery lesions in young adults with acute myocardial infarction.Subgroup analysis showed that NHR was significantly associated with the severity of coronary artery lesions in patients with BMI≥24 kg/m2,smokers,drinkers and non-drinkers(P＜0.05).No significant difference was observed in interaction analysis.The ROC curve showed that the area under the curve(AUC)predicted by NHR for acute myocardial infarction in young adults was 0.758,with a cut-off value of 7.0319,sensitivity of 83.3％,and specificity of 63.53％.Conclusion NHR has a certain value in predicting the severity of coronary artery lesions in young adults with acute myocardial infarction.

Correlation between neutrophil-to-lymphocyte ratio and disease activity in Behcet's disease / 天津医药

Objective To explore the correlation between neutrophil-to-lymphocyte ratio(NLR)and Behcet's disease(BD)activity.Methods A total of 103 BD patients were divided into the low activity group(0-4,61 cases)and the high activity group(5-11,42 cases)according to electronic medical record-based disease activity index(EMRAI)score.The white blood cell(WBC),neutrophil(NEU),lymphocyte(LY),platelet(PLT),red blood cell(RBC),hemoglobin(Hb),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),IgG,IgA,IgM,complement C3 and C4 were detected.NLR and platelet-to-lymphocyte ratio(PLR)were calculated.The correlation between NLR,PLR and ESR,CRP,EMRAI were analyzed.Logistic regression was used to analyze the influencing factors of BD disease activity.Receiver operating characteristic(ROC)curve was drawn to evaluate the effectiveness of NLR in judging BD disease activity.Results WBC,NEU,PLT,ESR,CRP,NLR,PLR,complement C3 and C4 in patients were higher in the high activity group than those in the low activity group(P＜0.05),and there were no significant differences in other indexes(P＞0.05).NLR was positively correlated with ESR,CRP and EMRAI in the whole group,while PLR was positively correlated with ESR,CRP and EMRAI in the whole group(P＜0.05).Logistic regression analysis showed that high NLR was a risk factor for BD disease activity(OR=1.511,95%CI:1.080-2.113,P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of NLR in evaluating BD disease activity was 0.706(95%CI:0.603-0.809).Conclusion NLR is effective in judging the disease activity of BD patients,and can be used as a biological index to evaluate the disease activity of BD.

Predictive value of monocyte to lymphocyte ratio,neutrophil percentage to albumin ratio for diabetic macular edema / 新乡医学院学报

Objective To investigate the value of monocyte to lymphocyte ratio(MLR)and neutrophil percentage to albumin ratio(NPAR)in predicting diabetic macular edema(DME).Methods One hundred and one diabetic retinopathy patients admitted to the Third Affiliated Hospital of Xinxiang Medical University from January 2018 to February 2023 were selected as the research subjects,and they were divided into DME group(n=56)and non-DME group(n=45)based on fun-dus examination results.The general data such as gender,age,course of diabetes and laboratory indicators were collected by consulting medical records.Fasting elbow venous blood was collected early in the morning of the next day after the diagnosis of DME in both groups,the monocytes(MONO)count,lymphocyte(LYM)count,white blood cell(WBC)count,percentage of neutrophils(NEUT),plasma albumin(ALB),glycosylated haemoglobin(HbA1c)were measured by full automatic blood routine analyzer,and MLR,NPAR were calculated.General information and laboratory indexes of patients in the two groups were compared,and risk factors for DME were analyzed by multivariate logistic regression,and receiver operator characteristic(ROC)curve was applied to evaluate the predictive value of MLR and NPAR for DME.Results The course of diabetes,MONO count,NEUT,MLR,NPAR,WBC count,and HbA1c level of patients between the DME group were significantly higher than those in the non-DME group(P＜0.05);there was no statistically significant difference in gender,age,LYM count,and ALB level of patients between the two groups(P＞0.05).Multivariate logistic regression analysis showed that increased levels of WBC,MLR,and NPAR were independent risk factors for the occurrence of DME(P＜0.05).The ROC curve showed that the best cut-off value of MLR was 0.192,and the area under the curve(AUC)for the prediction of DME was 0.729(95％confidence interval:0.631-0.826),with a sensitivity of 58.9％and a specificity of 82.2％;while the best cut-off value of NPAR was 1.404,and the AUC for predicting DME occurrence was 0.884(95％confidence interval:0.820-0.949),with a sensitivity of 75.0％and a specificity of 91.1％;the AUC of MLR and NPAP for predicting the occurrence of DME was 0.906(95％confidence interval:0.851-0.906),with a sensitivity of 69.6％and a specificity of 93.3％.With MLR＞0.192 as positive and NPAR＞1.404 as positive,the parallel test of MLR and NPAR predicted the occurrence of DME with a sensitivity of 87.5％,a specificity of 71.1％,and an accuracy of 80.2％;while the tandem test of MLR and NPAR predicted the occurrence of DME with a sensitivity of 46.4％,a specificity of 97.8％,and an accuracy of 69.3％.Conclusion Increased levels of MLR and NPAR are independent risk factors for the occurrence of DME and have certain predictive value for DME.The predictive value of combined MLR and NPAR test for DME is higher than that of separate test,and parallel experiment is more helpful for the early prediction of DME.

Correlation between platelet to lymphocyte ratio,neutrophil to lymphocyte ratio and carotid atherosclerotic plaque in patients with type 2 diabetes mellitus / 新乡医学院学报

Objective To explore the correlation between platelet to lymphocyte ratio(PLR),neutrophil to lymphocyte ratio(NLR)and carotid atherosclerotic(CAS)plaque in patients with type 2 diabetes(T2DM),and the predictive value of PLR and NLR for T2DM complicated with CAS plaque.Methods A total of 369 T2DM patients admitted to the Department of Endocrinology,the Third Affiliated Hospital of Xinxiang Medical University from September 2019 to November 2021 were se-lected as research subjects.The clinical data such as gender,age,course of disease,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),personal history,and history of past illness of patients were collected by searching the electronic medical record system.Neutrophil(NC)count,lymphocyte count(LC)and platelet(PLT)count were detected by fully automated blood routine analyzer,and PLR,NLR were calculated;the levels of fasting blood glucose(FBG),total cholesterol(TC),triglycerides(TG),high-density lipoprotein-cholesterol(HDL-C)and low-density lipoprotein-cholesterol(LDL-C)were detected by biochemical analyzer;the level of glycosylated hemoglobin(HbA1c)were detected by high-performance liquid chromatography.The T2DM patients were divided into T2DM uncomplicated with CAS plaque group(n=94)and T2DM complicated with GAS plaque group(n=275)based on whether they complicated with CAS plaque or not;the general clinical data,blood indicators,and PLR,NLR of patients were compared between the two groups.The T2DM patients were divided into non plaque group(group A,n=94),1 plaque group(group B,n=79),2 plaque group(group C,n=89),and 3 or more plaques group(group D,n=107)based on the number of CAS plaques;the indicators with statistical differences between T2DM uncomplicated with CAS plaque group and T2DM complicated with CAS plaque group of patients were compared among the four groups.According to the PLR quartile,the patients were divided into P1 group(PLR≤94.87,n=93),P2 group(94.87＜PLR≤117.30,n=91),P3 group(117.30＜PLR ≤ 148.53,n=93),and P4 group(PLR＞148.53,n=92),and the detection rate of CAS plaques of patients was compared among the four groups;according to the NLR quartile,the patients were divided into N1 group(NLR≤1.59,n=92),N2 group(1.59＜NLR≤1.93,n=92),N3 group(1.93＜NLR≤2.50,n=93),and N4 group(NLR＞2.50,n=92),and the detection rate of CAS plaque of patients was compared among the four groups.The risk factors of T2DM complicated with CAS plaque was analysed by multivariate logistic regression analysis,and the predictive efficacy of PLR and NLR for T2DM complicated with CAS plaque were evaluated by receiver operating characteristic(ROC)curve.Results The age,course of T2DM,proportion of patients combined with hyper-tension,SBP,PLR,and NLR of patients in the T2DM complicated with CAS plaque group were significantly higher than those in the T2DM uncomplicated with CAS plaque group,while LC and TG levels were significantly lower than those in the T2DM uncomplicated with CAS plaque group(P＜0.05);there was no significant difference in gender,proportion of patients com-bined with hyperlipidemia,proportion of smoking history,proportion of drinking history,and the levels of DBP,BMI,NC,PLT,TC,HDL-C,LDL-C,FBG,HbA1c between the T2DM uncomplicated with CAS plaque group and T2DM complicated with CAS plaque group(P＞0.05).The age,proportion of patients combined with hypertension,course of T2DM,SBP,PLR,and NLR of patients in group B,group C,and group D were significantly higher than that in group A,while LC level was significantly lower than that in group A(P＜0.05).The TG level of patients in group D was significantly lower than those in group A(P＜0.05);there was no statistically significant difference in TG level of patients among group A,group B,and group C(P＞0.05).The age,proportion of patients combined with hypertension,and course of T2DM of patients in group C and group D were significantly higher than those in group B,while the SBP of patients in group D was significantly higher than that in group B(P＜0.05);there was no statistically significant difference in SBP of patients between group C and group B(P＞0.05).The age,proportion of patients combined with hypertension,course of T2DM,and SBP of patients in group D were significantly higher than those in group C(P＜0.05).There was no statistically significant difference in the levels of LC,TG,and PLR of patients among group B,group C,and group D(P＞0.05).The NLR of patients in group D was significantly higher than that in group B(P＜0.05);there was no statistically significant difference in NLR of patients between group C and group B(P＞0.05),and there was no statistically significant difference in NLR of patients between group D and group C(P＞0.05).The detection rate of CAS plaques of patients in P1 group,P2 group,P3 group,and P4 group showed a significant increase trend(x2=30.610,P=0.000);and the detection rate of CAS plaques of patients in N1 group,N2 group,N3 group,and N4 group showed a significant increase trend(x2=35.170,P=0.000).Multivariate logistic regression analysis showed that age,PLR,and NLR were independent risk factors for T2DM complicated with CAS plaque(odds ratio=1.107,1.017,1.940;P＜0.05).The opti-mal cutoff value of PLR in predicting T2DM complicated with CAS plaque was 119.95,with an area under the curve of 0.680,a sensitivity of 54.7％,and a specificity of 76.3％;the optimal cutoff value of NLR in predicting T2DM complicated with CAS plaque was 1.97,with an area under the curve of 0.698,a sensitivity of 56.5％,and a specificity of 79.6％.Conclusion PLR and NLR are associated with T2DM complicated with CAS plaque,which are independent risk factors for T2DM compli-cated with CAS plaque,and have certain predictive value for T2DM complicated with CAS plaque.